PACE and PACENET Prescription Assistance for Pennsylvania Seniors

The Prescription Gap After Discharge

Your parent leaves a Pennsylvania hospital with a stack of new prescriptions — blood thinners, pain management, maybe a new diabetes medication — and the pharmacy bill hits harder than anyone expected. Medicare Part D covers some of it, but the copays add up fast, especially when a hospitalization introduces three or four new medications on top of what your parent was already taking.

Pennsylvania has two state-funded programs specifically designed to close this gap for seniors: PACE (Pharmaceutical Assistance Contract for the Elderly) and PACENET (PACE Needs Enhancement Tier). Both are funded by the Pennsylvania Lottery and administered by the Pennsylvania Department of Aging. They're not Medicaid, they're not Medicare Part D — they're a separate state benefit layer that can work alongside both.

PACE vs. PACENET: Which One Applies

The two programs share the same basic purpose but have different income thresholds and copay levels:

PACE (lower income):

• Age: 65 or older
• Residency: Pennsylvania resident for at least 90 days
• Income limit: Single person — $14,500/year or less; married couple — $17,700/year or less, based on prior-year gross income
• Copay: $6 for generic drugs, $9 for brand-name drugs

PACENET (moderate income):

• Age: 65 or older
• Residency: Pennsylvania resident for at least 90 days
• Income limit: Single person — $14,501 to $33,500/year; married couple — $17,701 to $41,500/year, based on prior-year gross income
• Copay: $8 for generic drugs, $15 for brand-name drugs

Eligibility uses prior-year gross income. Social Security benefits, pensions, interest income, and rental income all count.

How PACE and PACENET Work With Medicare Part D

This is where it gets confusing, and where many families miss out on benefits.

If your parent is enrolled in Medicare Part D (which most Medicare beneficiaries are), PACE and PACENET work with Part D as wrap-around benefits rather than simply replacing it. PACE may pay an eligible cardholder's Part D premium; PACENET cardholders generally pay a monthly Part D premium. The state programs supplement Part D and apply their own copay rules, so ask Cardholder Services how a deductible or coverage gap is handled for the specific plan.

If your parent is not enrolled in Part D, do not assume PACE or PACENET replaces Part D in every situation. Confirm the enrollment requirements with PACE Cardholder Services before relying on the program for prescription coverage.

Key detail: ask PACE Cardholder Services whether the coverage will be treated as creditable for your parent's Part D enrollment. Do not assume PACE/PACENET enrollment automatically waives a late-enrollment penalty.

How to Apply

Applications are available through:

• The PACE Cardholder Services line: 1-800-225-7223
• Your local Area Agency on Aging
• The Pennsylvania Department of Aging website
• Many hospital social work departments keep applications on hand

Required documentation: proof of age, proof of at least 90 days of Pennsylvania residency, and prior-year income documentation (Social Security award letter, pension statements, tax returns). Processing time varies, so apply early.

If your parent is being discharged from the hospital and needs prescriptions filled immediately, ask the discharge planner about the hospital's medication assistance program or manufacturer patient assistance programs to bridge the gap while the PACE application processes. Eligibility and timing vary by program.

After a Hospital Discharge: Medication Reconciliation Matters

The bigger picture here is that a hospital discharge is the most dangerous moment for prescription errors. Your parent's pre-hospital medication list and their post-discharge list are almost never identical. Drugs get added, changed, or discontinued during the stay, and the discharge medication list may conflict with what the primary care physician had originally prescribed.

Before worrying about cost, reconcile the medications. Sit down with the discharge medication list and your parent's pre-hospital list. Flag any discrepancies and bring them to the follow-up appointment with the primary care doctor promptly.

Then figure out cost. Between Medicare Part D, PACE/PACENET, and the pharmaceutical manufacturers' own assistance programs, very few Pennsylvania seniors should be paying full retail for prescriptions. The problem isn't that the programs don't exist — it's that nobody tells you about them in the hallway on discharge day.

For the full medication reconciliation process and a cost-coverage worksheet that maps each prescription to the right assistance program, the Pennsylvania Hospital Discharge Guide walks through it step by step.

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